Diagnosis and Treatment of Superior Sagittal Sinus Thrombosis

Introduction Cerebral venous sinus thrombosis (CVST), although a common diagnosis, is missed frequently by both general practitioners and neurologists. The most common presenting complaints are headache with focal neurological symptoms such as weakness, numbness, and aphasia. CVST has a female predominance of 3:1. A risk factor usually is able to be determined, most common of which is oral contraceptive use. Other prothrombotic risk factors include antithrombin III deficiency, dehydration, factor V Leiden mutation, increased factor VIII, infection, protein C and S deficiency, pregnancy, prothrombin mutation, malignancy, and trauma. The superior sagittal sinus is the most common site of cerebral venous thrombosis, followed by the other sinus systems. Treatment of CVST includes anticoagulation or thrombolytics with symptomatic support, although treatment with heparin has been controversial with some physicians hesitant to administer it due to the risk of hemorrhagic infarction. We report the diagnosis and treatment of superior sagittal sinus thrombosis.